Reintervention Rate Research Articles

Don’t mix it up! Long-term outcomes of different proximal aortic cuffs with the AFX endograft

The AFX unibody endograft offers advantages in treating abdominal aortic aneurysms (AAAs) with narrow aortic bifurcations due to its unique design, where the flow divider sits at the native aortic bifurcation. However, its limited length options may limit complete proximal neck utilization. As per device instruction for use, the implant should be completed with an aortic cuff. This study aims to evaluate the long-term outcomes of patients treated with an all-Endologix implant versus a combination of Endologix and Medtronic devices. This retrospective, single-center study included 134 consecutive AAA patients who underwent endovascular aneurysm repair (EVAR) using the AFX unibody endograft paired with suprarenal aortic cuffs from Endologix (n=86) or Medtronic (n=48) between November 2011 and November 2022. Patients were divided into 2 groups based on the type of aortic cuff used. The primary outcome was the occurrence of type 3A endoleaks at the longest available follow-up. Secondary outcomes included any endoleak, reintervention rates, all-cause mortality, and aneurysm-related death. The median follow-up was 41months, and type 3A endoleaks occurred after a mean 34.8months in 6 patients (4.5%), which is significantly more frequent in the mixed-device group (12.8%) (P<0.001). Type 3A endoleak occurred regardless of overlap and developed over time. Endoleaks of any type were reported in 17 patients. Reinterventions were needed in 12 patients. The use of an Endurant cuff was associated with a significantly increased risk of type 3A endoleaks (hazard ratio [HR] 16.5; 95% [CI] 1.9-143; P=0.011) and reinterventions (HR 9.67; 95% CI 1.9-49.6; P=0.006). Combining endografts from different manufacturers, especially those with differing materials and sealing mechanisms, may compromise the long-term integrity of certain EVAR repairs. Clinicians should exercise caution when considering mixed-device configurations and ensure rigorous follow-up for patients with such implants.

Robotic surgery for paediatric neurogenic lower urinary tract dysfunction: a systematic review.

To evaluate in a systematic review the outcomes, benefits, and limitations of robot-assisted surgeries for paediatric neurogenic lower urinary tract dysfunction (LUTD), as robot-assisted techniques have emerged as a potential alternative, offering enhanced precision, dexterity, and visualisation. This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO identifier CRD42023464849) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included studies of paediatric patients (aged <18 years) with neurogenic LUTD undergoing robot-assisted continence surgery, assessing safety and efficacy. Literature searches in the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), and Scopus were conducted until 12 July 2024. Data extraction included surgical procedures, complications, operative times, lengths of stay, and bladder function outcomes. A total of 42 studies (20 case reports, 10 case series, six cohort studies, six comparative cohort studies) were included. Robotic procedures for continent catherisable channel construction, augmentation cystoplasty, and bladder neck reconstruction showed comparable peri- and postoperative outcomes. Meta-analysis of five studies comparing robotic vs open appendicovesicostomy indicated a significant reduction in length of stay for robotic groups, while operative time, complications, and re-intervention rates were not significantly different. Conversions to open surgery were rare, indicated by adhesions or small appendices during channel constructions. Robot-assisted surgeries for paediatric neurogenic LUTD demonstrate potential benefits, including reduced hospital stays and comparable complication rates to open surgery in certain contexts. However, the available evidence is limited by heterogeneity in study designs, small sample sizes, and single-centre experiences, which constrain generalisability. Standardised reporting of complications and outcomes, alongside multicentre studies, is essential to clarify the long-term efficacy and broader applicability of these techniques.

Hybrid technique and total arch replacement combined with frozen elephant trunk in acute aortic dissection involving the aortic arch: a multi-center propensity-matched cohort study

BackgroundThe aim of this study was to investigate whether the hybrid technique yields superior outcomes in comparison with the total arch replacement combined with frozen elephant trunk (TAR + FET) for acute aortic dissection (AAD) involving the aortic arch.MethodsThis retrospective cohort study using propensity-score matching included patients with AAD involving the aortic arch admitted to Nanjing First Hospital and Shanghai General Hospital from January 2015 to June 2020. The in-hospital and mid-term outcomes were compared between patients who received hybrid treatment (n = 136) and those who received TAR + FET (n = 415). Study end points included in-hospital mortality and morbidity, and mid-term rates of death from all causes, stroke, and aortic re-intervention.ResultsA total of 121 pairs were formed after matching. In-hospital mortality did not differ between hybrid versus TAR + FET groups (5.8% vs. 7.9%, P = .860). Up to 6 years, patients treated with TAR + FET were associated with reduced rate of aortic re-intervention (HR 0.21, 95% CI 0.05–0.97; P = .023). There was no difference in death from all causes and stroke.ConclusionsHybrid technique and TAR + FET showed comparable mid-term survival. Hybrid technique showed higher rate of aortic re-intervention and should therefore be applied with great caution in patients with AAD involving the aortic arch.

Fenestrated Anaconda Endograft for the Treatment of Complex Aortic Aneurysms: Systematic Review and Meta-Analysis.

To perform a systematic review and meta-analysis of the outcomes of Anaconda fenestrated endograft for the treatment of complex abdominal aortic aneurysms (cAAA). A systematic search of all the literature reported until May 2024 was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The pooled 30-day mortality rate, technical success rate, reintervention rate as well as bridging stent occlusion rate, and corresponding 95% confidence intervals (CIs) were estimated using fixed or random effect methods. A total of 526 study titles were identified by the initial search strategy, of which 6 were considered eligible for inclusion in the meta-analysis. A total of 782 patients (89% male) were identified among the eligible studies. The pooled 30-day mortality rate was 4.8% (95% CI, 3.5%-6.5%) while the reintervention rate was 7.9% (95% CI, 4.3%-14.1%) and 10.2% (95% CI, 5.8%-17.4%) in the early and late period, respectively. The pooled bridging stents occlusion was 2.7% (95% CI, 1.5%-4.9%) during 30 days and 3.5% (95% CI, 1.6%-7.6%) during follow-up. Overall technical success was 86.1% (95% CI, 62.9%-95.8%). The use of the Anaconda fenestrated endograft in treatment of complex aortic aneurysms involving the abdominal visceral vessels has low early and late mortality. Low rate of bridging stent occlusion occurs early postoperatively and during follow-up, mostly involving the renal arteries. Reinterventions during follow-up are mostly induced by limb occlusion. Lower early technical success rate is explained by the presence of a type Ia endoleak on final angiography, which however resolves spontaneously early postoperatively. The present systematic review and meta-analysis of observational studies provide evidence-based data regarding the safety and efficacy of the fenestrated Anaconda device for the primary treatment of cAAA in the perioperative period and at long-term follow-up. Six studies with an overall 782 patients were included. The technical success in patients with cAAA treated with Anaconda fenestrated endograft was 86% while the reintervention rate was 7.9% and 10.2 during the perioperative and long-term follow up period. The pooled 30-day occlusion rate for the bridging stents was 2.7% while the late pooled occlusion rate for the bridging stents among the studies was 3.5%. The use of the Anaconda fenestrated endograft in treatment of complex aortic aneurysms involving the abdominal visceral vessels seems feasible with promising outcomes. The lower early technical success is obscured by the presence of type Ia endoleak which, resolves spontaneously early postoperatively.

Long Term Results of a Comparative Study of Percutaneous and Surgically Created Proximal Forearm Arteriovenous Fistulae.

This retrospective, single centre, comparative effectiveness study aimed to compare the long term outcomes of percutaneous arteriovenous fistulae (pAVF) and surgically created arteriovenous fistulae (sAVF) created in the proximal forearm for haemodialysis access. Data were reviewed from a prospectively maintained database on patients who underwent pAVF or sAVF creation from September 2017 to September 2023. A total of 217 pAVFs (61 WavelinQ and 156 Ellipsys) and 158 sAVFs were analysed. Outcome measures included technical success, maturation, patency, time to first successful use, re-interventions, and complications. Technical success was 100% for sAVF and Ellipsys, and 93.4% for WavelinQ (p < .001). Maturation at four weeks was higher in Ellipsys (78.6%) and sAVF (79.7%) groups than in WavelinQ (64.9%) (p = .042). Median time to first cannulation was shortest for Ellipsys (57 days), followed by sAVF (73 days), and longest for WavelinQ (98.6 days) (p = .048). Average follow up was 654 days (interquartile range 164, 1 049 days; range 0 - 2 061 days). Primary patency was higher in sAVF than in pAVFs. The Cox proportional hazard ratio (HR) for loss of primary patency was 1.50 for WavelinQ and 1.42 for Ellipsys compared with sAVF (p = .045). Secondary patency was statistically significantly lower for WavelinQ (HR 2.76; p < .001), but not for Ellipsys (HR 0.74; p = .33). Haemodialysis access induced distal ischaemia (HAIDI) was more common in the sAVF group with nine events (5.7%) compared with one for the Ellipsys (0.64%; p = .008). Re-intervention rates per patient year were comparable across groups (0.60 vs. 0.61 vs. 0.69 for sAVF, WavelinQ, and Ellipsys, respectively). This study indicates that while all access types can provide long term functional haemodialysis access, sAVFs perform better in some outcome domains and pAVFs (particularly Ellipsys) in others, with sAVF showing higher rates of HAIDI, yet lower rates of juxta-anastomotic stenosis. The findings underscore the importance of personalised vascular access planning, weighing immediate procedural outcomes against long term functionality.

Outcomes of chronic limb-threatening ischemia revascularization in patients with chronic kidney disease in the BEST-CLI trial.

Chronic limb-threatening ischemia (CLTI) in patients with chronic kidney disease (CKD) has a high risk of poor outcomes. We aimed to compare the outcomes of lower extremity revascularization in patients with CLTI stratified by CKD severity in patients enrolled in the prospective, randomized Best Endovascular vs Best Surgical Therapy in Patients with CLTI (BEST-CLI) trial. The BEST-CLI trial dataset was queried to categorize patients into three groups according to CKD stage. Group A includes non-CKD and CKD stages<3; group B includes stage 3 and stage 4 CKD patients; and group C includes stage 5 CKD and dialysis-dependent patients. Furthermore, spline modeling was performed across the range of estimated glomerular filtration rate (eGFR, mL/min/1.73m2) observed in study participants to identify a threshold eGFR that impacted the primary trial outcomes: major adverse limb events (MALEs; defined as above-ankle amputation or major reintervention) or all-cause mortality, by surgical or endovascular revascularization (as-treated analysis). Kaplan-Meier and multivariate Cox regression analyses were used to assess association of CKD risk groups with the outcomes. A total of 1797 patients were included. Group C patients had double the risk of amputation (hazard ratio [HR], 2.13; P< .001), MALE, or all-cause mortality (HR, 2.05; P< .001) and more than triple the risk of all-cause mortality (HR, 3.40; P<.001) compared with group A. In dialysis-dependent patients, endovascular therapy was associated with better survival, but twice the risk of reintervention compared with surgical revascularization. According to spline model analysis, hazard of MALE or all-cause mortality increased sharply at eGFR<30. The hazard ratios for eGFR<30 vs ≥60 were 2.03 (95% confidence interval [CI], 1.68-2.43; P< .001) and 3.46 (95% CI, 2.80-4.27; P< .001) for MALE and mortality, respectively. At eGFR<30, there was no difference in the primary outcome by treatment received (surgical or endovascular revascularization). The progressive nature of renal impairment in patients with CLTI threatens their survival and limb salvage and may reduce the relative benefit of open vs endovascular revascularization seen in the overall BEST-CLI trial population. In dialysis-dependent patients, endovascular therapy was associated with lower mortality but increased reintervention rate.

The treatment of acute traumatic aortic injuries with TEVAR: a retrospective analysis of 19 cases in a level-1 trauma center

IntroductionBlunt traumatic aortic injury (TAI) is a critical condition and a leading cause of mortality in trauma patients, often resulting from high-speed accidents. Thoracic endovascular aortic repair (TEVAR) has developed into the preferred therapeutic approach due to its minimally invasive nature and promising outcomes. This study evaluates the safety and efficacy of TEVAR for managing TAI over a 10-year period at a Level-1 trauma center.MethodsA retrospective analysis was conducted on 19 patients with acute TAI treated with TEVAR between 2012 and 2022 at the University Hospital Zurich. Data were collected from digital records and analyzed according to the Fillinger TEVAR reporting framework. Outcomes included technical success, perioperative complications, and long-term graft durability.ResultsThe cohort had a mean age of 39 years and included patients with severe polytrauma. Technical success was achieved in 95% of cases, with no intraoperative deaths or need for open surgical conversion. Perioperative complications were minimal, and the reintervention rate was 5.3%. This study evaluates 10 years of clinical experience managing TAI with TEVAR. Long-term follow-up, with a median duration of 29 months, revealed no graft-related complications or secondary interventions. Imaging confirmed sustained graft integrity, and clinical outcomes were favorable.ConclusionTEVAR is a reliable and effective treatment for traumatic aortic injuries, offering excellent technical success rates and minimal perioperative and long-term complications. This study highlights TEVAR’s advantages in managing polytrauma patients and its role as a minimally invasive alternative to open surgery. Additionally, the findings emphasize the need for comprehensive long-term follow-up protocols. Future research should aim to address challenges related to device durability and the integration of advanced imaging techniques to further enhance patient outcomes and broaden the applicability of TEVAR in trauma care.

Middle meningeal artery embolization for chronic subdural hematoma in the nonagenarian population.

The estimated incidence of chronic subdural hematomas (cSDH) in the general population is projected to nearly double over the next decade, likely making it the most commonly treated cranial neurosurgical condition in adults by 2030. We investigated the outcomes of middle meningeal artery embolization (MMAe) as either a primary or adjunctive treatment for cSDH in nonagenarian patients. We retrospectively reviewed all patients 90 years of age or older treated with middle meningeal artery embolization for cSDH from 2018 to 2024 at two academic institutions. Statistical analysis was performed on patient demographics, baseline functional status, intervention, cSDH size, recurrence rate, reintervention rate, and follow-up functional status. Twenty-one patients aged 90 or older were identified who were treated with MMAe for cSDH. Hematoma thickness ranged from 10mm to 34mm with a mean midline shift of 4.6mm. Eighteen patients were treated with MMAe alone, while three patients underwent surgery followed by MMAe. A total of 20 patients had radiological follow up, with no evidence of growth or recurrence in 95 % of the patients. There was one recurrent cSDH in our cohort in the setting of new trauma after hospital discharge. There was one complication related to the MMAe procedure which was a femoral artery pseudoaneurysm that resolved without further treatment. Median baseline mRS was 3 prior to MMAe and median follow-up mRS after treatment was 2. MMAe is a safe and efficacious treatment for nonagenarian patients with cSDH, and shows promise as a potential primary treatment modality.

Impact of Sex-Related Differences in Infrarenal Aortic Neck Morphology on Outcomes of Endovascular Aneurysm Repair for Similar-Sized Aortic Aneurysm.

Objectives: This study aimed to evaluate whether gender-related anatomical differences in proximal aortic neck morphology affect the feasibility and outcomes of endovascular aortic aneurysm repair (EVAR) in women with abdominal aortic aneurysms (AAA). Methods: This study performed a retrospective analysis of patients electively treated by EVAR for infrarenal AAA between January 2019 and December 2023. Demographics, anatomical characteristics, and stent graft details were analyzed. The primary endpoint was technical success. Secondary endpoints included freedom from aortic and neck-related reinterventions, endoleak rate, and freedom from aneurysm-related mortality during follow-up. Technical aspects, including adherence to the instructions for use (IFUs), were retrospectively analyzed. Results: One-hundred-seventeen patients (fifty-six females; mean age 76.2 ± 5.3 years) underwent elective EVAR for AAA. Demographics and comorbidities were homogeneous across genders. Female patients (Group A) demonstrated a higher prevalence of hostile proximal aortic neck features, including neck length < 10 mm and angulation > 60° (p = 0.009, p = 0.029, respectively) and a higher frequency of off-label EVAR procedures (28.6% vs. 11.5%; p = 0.034). The overall technical success rate was 98.3%, with no significant differences between genders in terms of stent graft selection, use of suprarenal fixation, or incidence of type 1-3 endoleaks. The median follow-up period was 35.2 ± 12.7 months, showing comparable rates of neck-related reinterventions, open conversions, and aneurysm-related mortality between genders. Notably, off-label EVAR was identified as an independent risk factor for type 1A endoleaks, reinterventions, and aneurysm-related mortality (p < 0.00001, p < 0.0001, and p = 0.001, respectively). Conclusions: Female patients undergoing EVAR often present with hostile proximal aortic neck features and are treated at an older age than males. Despite these differences, technical success rates and mid- to long-term outcomes were comparable between genders, with no variation in stent graft selection or suprarenal fixation use. Effective procedural planning, device selection, and surgical expertise appear to mitigate historical gender-related anatomical challenges. Further large-scale studies are needed to confirm whether anatomical factors alone drive outcomes, irrespective of gender.

Valve Sparing Aortic Root Replacement in the Resternotomy Setting.

While valve-sparing aortic root replacement (VSRR) has demonstrated satisfactory outcomes, its utility in a reoperative sternotomy setting remains uncertain. This study evaluates the perioperative safety and long-term durability of reoperative sternotomy VSRR. All consecutive VSRR at two centers from 2005-2020 were included. Reoperative VSRR was defined as prior sternotomy for any reason. Time-dependent outcomes were compared between groups after balancing of covariates with inverse probability of treatment weighting. Multivariable Cox regression and Fine-Gray sub-distribution hazard model were used to identify factors associated with 10-year survival and aortic valve (AV) reintervention, respectively. Of 778 VSRR, 69 (8.9%) were reoperative sternotomies. Compared to primary, reoperative VSRR patients were younger (43 [34-54] vs 51 [39-61] years, p<0.001) and had less aortic insufficiency (33.3% vs 48.5%, p=0.02). Cardiopulmonary bypass times were longer in reoperative VSRR with similar rates of circulatory arrest. Reoperative VSRR had a higher incidence of postoperative acute kidney injury (10.1% vs 3.2%, p=0.01) and prolonged ventilation (24.6% vs 9.9%, p<0.001); operative mortality was higher in reoperative VSRR (2.9% (2/69) vs 1.4% (10/709)) although not significantly (p=0.66). Ten-year survival was 82.0% [70.0-96.0] and AV reintervention rate was 11.8% [2.3-19.4] after reoperative VSRR. After IPTW adjustment, survival and AV reintervention rates were not different. Reoperative sternotomy was not associated with long-term mortality (p=0.13) or AV reintervention (p=0.77) on multivariable analysis. Although complex, reoperative sternotomy VSRR can be performed with low operative mortality in carefully selected patients. Ten-year survival and AV reintervention rates were acceptable and comparable to primary VSRR.

The Effectiveness of Surgical Thrombectomy via Below-Knee Popliteal Artery for the Treatment of Acute Limb Ischemia.

Objectives: Surgical thrombectomy has been established as an effective treatment for acute limb ischemia (ALI). Nevertheless, manipulation via the common femoral artery (CFA) to retrieve thrombus in the infra-popliteal artery sometimes proves less effective. Methods: We retrospectively reviewed patients undergoing surgical thrombectomy for infra-inguinal ALI from January 2010 to December 2022. The primary endpoint was the rate of amputation. Secondary endpoints were technical and clinical success rates, incidence of distal embolism, and freedom from reintervention. Results: A total of 35 patients underwent surgical thrombectomy where the popliteal artery or below is occluded. The CFA approach was utilized in 13, and the below-knee popliteal artery (BKPA) approach in 22. There were no differences in background between groups. The reintervention rate was lower in the BKPA group (BKPA group: 0% vs. CFA group: 30.8%; P = 0.01). The BKPA group showed a significantly lower incidence of distal embolism (BKPA group: 4.5% vs. CFA group: 38.5%; P = 0.02) and freedom from reintervention (BKPA group 100% at 12 months vs. CFA group: 68.7% at 12 months; log-rank P = 0.01). Conclusions: The BKPA approach-first strategy for surgical thrombectomy in the management of ALI is feasible with better outcomes compared with the CFA approach.

Comparison of treatment outcomes between graft replacement and aneurysmorrhaphy with graft preservation for type 2 endoleaks after endovascular abdominal aortic aneurysm repair.

This study aimed to compare treatment outcomes between graft replacement and aneurysmorrhaphy with ligation of the aortic side branches for type 2 endoleaks after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms. We retrospectively analyzed multicenter data of patients who underwent open surgical conversion, including graft replacement or aneurysmorrhaphy with ligation of the aortic side branches (graft preservation) for the treatment of type 2 endoleaks between 2007 and 2022. The endpoints were postoperative complications, 30-day mortality, overall survival, and reintervention or sac expansion after open surgical conversion. Forty patients underwent open surgical conversion (graft replacement, n=9; graft preservation, n=31). There were no significant differences in patient characteristics or anatomical data of the initial EVAR between the groups. The median operative time and amount of blood loss were significantly lesser in the graft preservation group than in the replacement group (179 vs. 318 min, P < .001 and 710 vs. 2,567 mL, P = .030, respectively). There was no difference in the occurrence of postoperative complications between the two groups (P = .645). No 30-day mortality was observed in any of the groups. Overall survival rate at 5 years after open surgical conversion was 85.7% in the graft replacement group and 77.8% in the graft preservation group (P = .789). Freedom from sac expansion or reintervention rate at 5 years after open surgical conversion was 100% in the graft replacement group and 76.0% in the graft preservation group (P = .239). Aneurysmorrhaphy with ligation of the aortic side branches was less invasive treatment compared with graft replacement, although there were no differences in postoperative complications. No reintervention was needed after graft replacement; however, some patients required reintervention after graft preservation. Further studies are needed to determine the optimal surgical procedure for the treatment of type 2 endoleak.

Impact of Surgeon Specialization on Outcomes in Emergency Colorectal Surgery: A Systematic Review and Meta-analysis.

Colorectal emergencies represent a large proportion of acute general surgical workload and carry significant mortality. Identify the influence of surgeon specialization on mortality and other outcomes in emergency colorectal surgery. Systematic searches of Ovid MEDLINE, Ovid Embase, and Cochrane electronic databases were performed for studies published from January 1, 1990, to August 27, 2023. Studies investigating outcomes in emergency colorectal surgery for adults, comparing colorectal against noncolorectal surgeon specialization, were included. Exclusion criteria were: 1) publications studying primarily pediatric populations; 2) studies incorporating patients who had undergone surgery before 1990; and 3) studies only published in abstract form or non-English language. Primary outcomes were 30-day mortality and in-hospital mortality. Secondary outcomes were rates of anastomotic leak, reintervention, primary anastomosis, and laparoscopic approach. Of 7676 studies identified, 155 were selected for full-text review and 21 were included for quantitative analysis. Eleven studies showed improved 30-day (OR 0.64; 95% CI, 0.60-0.68; p < 0.0001) and in-hospital mortality (OR 0.66; 95% CI, 0.49-0.89; p = 0.007) with colorectal specialization. There was a significantly higher rate of primary anastomosis (OR 2.95; 95% CI, 2.02-4.31; p < 0.0001) and use of laparoscopic surgery (OR 2.38; 95% CI, 1.42-4.00; p = 0.001) among specialized colorectal surgeons. Specialization was also associated with a significant reduction in any stoma formation (OR 0.52; 95% CI, 0.28-0.98; p = 0.04). No significant difference was observed for anastomotic leak (OR 0.70; 95% CI, 0.45-1.07; p = 0.10) or reintervention rates (OR 0.78; 95% CI, 0.55-1.10; p = 0.16). Heterogeneity exists within the included patient populations and definitions of colorectal specialization observed in different countries. Emergency colorectal surgery undertaken by specialized colorectal surgeons is associated with significantly improved postoperative mortality, lower rates of stoma formation, and increased rates of primary anastomosis and minimally invasive surgery. CRD42022300541.

Comparison of Embolization Coils and Patent Ductus Arteriosus Occluders for Coronary Artery Fistula Transcatheter Closure: A Single Centre Experience.

There is no dedicated occlusive device for closing coronary artery fistulas (CAFs), and specific efficacy and safety data of various off-label occlusive devices for CAFs closure are scarce. Patients undergoing transcatheter closure of CAFs from January 2011 to December 2022 were included in the single-center retrospective study. The study population was divided into 2 groups: coils group (n=35) and patent ductus arteriosus (PDA) occluders group (n=66). No significant intergroup differences were observed in demographic characteristics except age. The presence of multiple CAF origins (54.3% vs. 4.5%, p<0.001) and multiple draining sites (51.4% vs. 3.0%, p<0.001) were more common in the coils group. In contrast, the presence of aneurysm (72.7% vs. 14.3%, p<0.001), and large fistula (75.8% vs. 37.1%, p<0.001) were more prevalent in the PDA occluders group. The acute procedural success rate of the PDA occluders group was higher compared to that of the coils group (87.9% vs. 62.9%, adjusted odds ratio [OR], 7.20; 95% confidence interval, 1.59-32.64; p=0.01). In addition, no significant intergroup differences were noted in both the recanalization rate (7.8% vs. 20%, p=0.107) and the reintervention rate (3.1% vs. 8.6%, p=0.342). Transcatheter closure of CAFs using PDA occluders was associated with significantly higher acute procedural success rates compared to coil embolization with comparable late outcomes.

The Effect of Aneurysm Diameter on Perioperative Outcomes Following Complex Endovascular Repair.

Endovascular aneurysm repair (EVAR) for large infrarenal abdominal aortic aneurysms (AAA) has been associated with worse outcomes compared to EVAR for smaller AAAs. Whether these findings apply to complex AAAs (cAAA) remains uncertain. We identified all intact complex EVAR (cEVAR) from 2012-2024 in the Vascular Quality Initiative. cEVAR was defined as having a proximal extent between zones 6-9 and at least one side branch/fenestration/chimney/parallel grafting. Aneurysm size was defined as follows: large: >65 mm (males), >60 mm (females); medium: 55-65 mm (males), 50-60 mm (females); and small: <55 mm (males), <50 mm (females). We assessed perioperative death, any complication, and in-hospital reintervention using logistic regression and mid-term mortality using adjusted Kaplan-Meier methods and Cox regression. Medium-sized aneurysms were compared to large and small aneurysms. Of 3,426 patients, 22.6% had large, 60.4% medium, and 17.0% had small aneurysms. As compared to medium and small aneurysms, large aneurysms demonstrated higher rates of perioperative death (4.8% vs. 2.6% vs. 0.5%), any complication (33.3% vs. 23.6% vs. 19.4%), and in-hospital reintervention (6.2% vs. 4.0% vs. 2.6%) (all p<.05). Median follow-up was 445 days. One-year mortality rates were higher in large aneurysms (12.3% vs. 7.8% vs. 3.8%; p<.001). After adjustment, when compared with medium-sized aneurysms, large aneurysms were associated with a significantly higher risk of perioperative death (adjusted odds ratio [aOR], 1.73; 95% confidence interval [CI], [1.09-2.72]), any complication (aOR, 1.44; [1.18-1.76]), and mid-term mortality (adjusted hazard ratio [aHR], 1.50; [1.19-1.88]), but not in-hospital reintervention (aOR, 1.46; [0.99-2.13]). While small aneurysms, as compared with medium-sized aneurysms, did not demonstrate a difference in any complication (aOR, 0.87; [0.68-1.10]), in-hospital reintervention (aOR, 0.77; [0.42-1.33]), and mid-term mortality (aHR, 0.78; [0.57-1.08], they did demonstrate a lower risk of perioperative death (aOR, 0.26; [0.06-0.71]). In cEVAR for cAAA, large aneurysms, compared with medium-sized aneurysms, were associated with higher rates of perioperative death, any complication, and mid-term mortality, with in-hospital reintervention trending toward a statistically significant higher risk. While these results align with expectations, they emphasize the importance of effectively managing patients with large cAAAs and highlight the need for future research to determine whether patients might benefit more from medical therapy or open repair.

Assessment of Outcomes & Anatomical Changes in the Upper Urinary Tract following Flexible Ureteroscopy with a Flexible and Navigable Suction Ureteral Access Sheath (FANS): 3-Month Results from a Multicenter Study.

To study the long-term outcomes of the flexible and navigable suction ureteral access sheath (FANS) in flexible ureteroscopy (FURS). FANS has well-established efficiency and 30-day perioperative safety; however, its influence on pelvicalyceal and ureteric anatomy remains to be investigated. This was a prospective study of patients with normal renal anatomy who underwent FURS with FANS for renal stones from April 2023 to August 2024 in 16 centers worldwide. 30-day postoperative stone free rate and delayed complications after 3 months were analyzed with a non-contrast CT scan and contrasted CT urogram respectively. The primary aim was to report if FANS could potentially cause pelviureteric junction, pelvicalyceal or ureteric complications. 310 patients were analyzed. Median age was 51; median stone volume was 1584 mm3. Disposable scopes were used in 58.1%. Predominant laser energies were Thulium fiber laser (56.1%) followed by Thulium-YAG laser (20.6%). Median laser time was 14min, median ureteroscopy time was 30min, and median total operation time was 45min. Ureteric injury occurred in 11 patients (3.5%), of which 10 were Traxer-Thomas Grade 1. On 30-day NCCT, 63.5% of patients had zero residual fragments; overall stone-free status was seen in 95.1%. 30-day reintervention rate was 4.2% (13 cases). 3-month CT urogram showed ureteric stenosis in only 1 patient (0.3%) who was managed by dilatation and stenting. No other anatomical anomalies were recorded. The extremely low rates of 3-month adverse outcomes, high immediate SFR, and low 30-day reintervention rates further strengthen the evidence for safety and effectiveness of FANS.

Low-profile double plating versus conventional single plating in midshaft clavicle fractures: A retrospective study and initial experience with this novel technique.

Low-profile double plating seems a viable alternative to conventional single plating for fixation of midshaft clavicle fractures. This study aims to compare the two techniques regarding healing, complications, and removal rate. This retrospective cohort study included all patients >16 years that underwent plate fixation for midshaft clavicle fractures between 2020 and 2022 at one trauma-center. Exclusion criteria encompassed pathological or open fractures, refractures and delayed presentation or treatment more than 14 days after the accident. Patients were categorized into two treatment groups: Single plating (Synthes 3.5mm LCP superior / anterior or Synthes 2.7mm VA-LCP superior) and low-profile double plating (2.0 superior combined with either 2.4 or 2.7mm anterior mini-plate). Treatment groups were compared regarding healing, complications, and removal rate. A total of 99 patients were included: 74 in the single plating and 25 in the double plating group. Implant failures within the first three months were comparable in both groups (4.0% double plating versus 2.7% single, p = 0.744, of which one was caused by infection). Low-profile double plating had a significantly lower operation duration (95 versus 111 minutes, p = 0.019). Long-term follow-up data was available in 60 patients in the single plating and 20 in the double plating group. The need for reintervention was significantly lower in the double plating group (n = 5, 25.0% vs. n = 31, 51.7%, p = 0.038). These reinterventions were predominantly caused by implant irritation in both groups (n = 4, 20% double plating versus n = 29, 48.3% single plating, p = 0.026). All fractures healed in both groups. Low-profile double plating attains comparable healing rates as single plating and has a significantly lower risk for re-intervention as well as a shorter operation duration. The lower reintervention rate is mainly explained by a lower incidence of implant irritation in the double plating group.

Efficacy and safety of a dedicated venous stent for the treatment of iliofemoral venous obstruction: A single center experience

Background Endovascular recanalization with venous stenting is the preferred treatment for iliofemoral venous obstruction. We reviewed our institutional experience and mid-term outcomes with endovascular therapy for iliofemoral venous obstruction using the VenovoTM Self-expanding Venous Stent (BARD Peripheral Vascular, Inc., Tempe, AZ, USA). Methods Between October 2022 and March 2024, patients with iliofemoral venous obstruction treated with VenovoTM Self-expanding Venous Stents were retrospectively analyzed. Patients were monitored at 3, 6, and 12 months. The primary endpoint was 12-month primary patency, defined as computed tomography venography-derived stenosis &lt;50% and no target venous revascularization. Secondary endpoints included stent intimal hyperplasia and pain venous clinical severity scores (VCSSs). Results We evaluated 51 limbs from 40 patients (mean age: 61.7 ± 10.7 years; 26 females), including three acute deep venous thrombosis (DVT)cases, six post-thrombotic syndrome (PTS) cases, and 42 non-thrombotic iliofemoral vein lesion cases. All (100%) underwent successful endovascular treatment, with five undergoing combined stent deployment. The interventional operation-related complication rate was 1/51 (1.96%). The median follow-up was 14.6 months (range: 12–18 months). The primary patency rate at 1 year was 90%. Freedom from stent intimal hyperplasia at 12 months was 74.51% (38/51), and 3.92% (2/51) had in-stent stenosis &gt;50%, which was reduced after high-pressure balloon dilation at 6 months. The mean VCSS decreased from a baseline of 13.1.7 ± 3.7 to 3.3 ± 1.6 at 12 months ( p &lt; .0001). No complications were noted during follow-up. Conclusions Stenting iliofemoral venous obstruction using the VenovoTM Self-expanding Venous Stent appears to be safe and effective, with a high rate of 1-year clinical patency and a low reintervention rate.

Tips and Tricks to Facilitate Late Open Surgical Conversion after Endovascular Aortic Aneurysms Repair.

Endovascular repair has significantly improved the treatment of aortic aneurysms, particularly in older and high-risk patients. However, many studies have not found significant differences in long-term outcomes when comparing open and endovascular repair methods. Additionally, endovascular repair is associated with a higher rate of aortic-related reinterventions compared to open repair (OR), sometimes necessitating late open surgical conversion (LOSC). The increasing number of endovascular aortic aneurysm repairs exposes vascular surgeons to a growing number of patients requiring late open surgical conversion (LOSC) after previous endovascular aneurysm repair (EVAR) or thoracic endovascular aortic repair (TEVAR). LOSC following endovascular procedures is associated with higher perioperative mortality and complication rates compared to primary open repair of aortic aneurysms. This review summarizes the current knowledge, indications, possibilities, and techniques for LOSC after initial endovascular procedures. While the incidence of complications requiring LOSC remains relatively low, the number of endovascular procedures performed has increased significantly over the last decade, suggesting a rise in LOSC procedures as well. Due to the complexity involved, LOSC procedures should be performed in high-volume centers by highly experienced vascular surgeons. This underlines the importance of educating the younger generation of vascular surgeons in both endovascular and open aortic surgery.

Assessing flexible ureteroscopy outcomes for lower Pole versus non lower Pole stones using the flexible and navigable suction ureteric access sheath: a prospective multicenter study by EAU Endourology and PEARLS group.

Use of suction in flexible ureteroscopy is increasing lately. The introduction of flexible and navigable suction access sheath (FANS) has shown improved stone free rate (SFR). However, its efficacy in lower pole stone (LPS) in terms of SFR and complications is yet to be studied. We collected data from 25 centers that included 394 adult patients undergoing ureteroscopy using FANS. Non contrast CT (NCCT) scan was done within first 30 days post operatively to access the SFR. Residual fragments were graded as A: 100% SFR; B: single fragment ≤ 2mm; C: single fragment 2.1-4mm; D: Single or multiple fragments > 4mm. Post operative complications were recorded. Out of 394 patients, non LPS (group1) comprised of 268 patients, rest 126 patients had LPS (group 2). Single stage zero fragment SFR was seen in 58.6% (group 1) vs. 54.8% (group 2) (P = 0.619). Single stage grade A + B SFR was achieved in 96.6% vs. 98.4% in groups 1 and 2 respectively. On multivariate analysis Thulium fiber laser use was significantly associated with higher odds of being grade A stone-free, while stone volume with lower odds. In LPS group only two patients needed reintervention. The highest grade of complication was Clavien 2, which was seen in 3.2% LPS group. Use of flexible and navigable suction ureteric access sheath for lower pole stones is effective and safe. The stone free rate of lower pole stones is comparable to non-lower pole locations with very low reintervention rate in both groups.